Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON.
McMaster University Medical Centre; and Department of Diagnostic Imaging, Juravinski Cancer Center, Hamilton Health Sciences, Hamilton, ON.
Tomography. 2020 Sep;6(3):308-314. doi: 10.18383/j.tom.2020.00031.
Our institution recently implemented the use of digital tomosynthesis (DTS) to workup emergency room patients with suspected hip fractures after initial negative or indeterminate radiographs. Our purpose is to evaluate the diagnostic accuracy of DTS for hip fracture detection. We performed a retrospective review of all DTS studies over a 17-month period (July 2017 to November 2018). The results of the radiographs and DTS were recorded as either positive or negative for fracture based on the radiology report. Our reference standard for a fracture was either confirmation on subsequent CT or MRI from the same visit or documentation of clinical findings supportive of a fracture in the patient's electronic medical record. For patients with negative DTS who did not undergo subsequent cross-sectional imaging, a missed fracture was excluded if they did not return within 30 days with a confirmed fracture. Among 91 patients, there were 34 confirmed fractures-sites including, 7 femoral necks, 10 pubic rami, and 7 greater trochanters. DTS was positive for fracture in 29 patients; 28 of these fractures were true positives, 6 confirmed on cross-sectional imaging, and 22 confirmed clinically. One false positive was observed in a patient with no clinical evidence of a fracture. Six fractures were not detected by tomosynthesis but confirmed on CT/MRI. The sensitivity and specificity of DTS are 82% and 98%, respectively, compared to that of radiographs alone at 47% and 96%, respectively. DTS is a promising adjunct to radiographs for hip fracture detection in an emergency department.
我们机构最近开始在急诊室中使用数字断层合成摄影术（DTS）对疑似髋部骨折的患者进行检查，这些患者的初始 X 线片为阴性或不确定。我们的目的是评估 DTS 对髋部骨折检测的诊断准确性。我们对 17 个月（2017 年 7 月至 2018 年 11 月）期间的所有 DTS 研究进行了回顾性分析。根据放射科报告，X 线片和 DTS 的结果分别记录为骨折阳性或阴性。我们将骨折的参考标准定义为同一就诊时后续 CT 或 MRI 的证实结果，或在患者电子病历中记录支持骨折的临床发现。对于 DTS 结果为阴性且未进行后续影像学检查的患者，如果在 30 天内未因确诊骨折而返回医院，则可排除漏诊骨折。在 91 例患者中，有 34 例确诊骨折，包括 7 例股骨颈骨折、10 例耻骨支骨折和 7 例大转子骨折。29 例 DTS 结果为阳性，其中 28 例为真阳性，6 例经影像学证实，22 例经临床证实。1 例假阳性见于无临床骨折证据的患者。6 例骨折未被 DTS 检测到，但在 CT/MRI 上得到了证实。与单独使用 X 线片相比，DTS 的灵敏度和特异性分别为 82%和 98%，而 X 线片的灵敏度和特异性分别为 47%和 96%。DTS 是急诊科中用于髋部骨折检测的一种有前途的 X 线片辅助检查方法。
